Disclaimer/friendly advice: We are not legal counsel. Using this site, you agree that we have in no way represented ourselves to you as legal counsel. No partnership has been implied or created between LibraryOfLegalForms and you. This site exists for informational purposes only. As with all legal matters, you should have an attorney review any documents before you sign them. We offer you access on this site to some of the best and least expensive ways to have legal forms reviewed and to discuss them with an attorney.

Application for a License as an Ocean Transportation Intermediary

This is a Federal Maritime Commission application for a license as an ocean transportation intermediary (United States). The form provided here is simply a sample of what the actual Form FMC-18 looks like.

APPLICATION FOR A LICENSE
AS AN OCEAN TRANSPORTATION INTERMEDIARY

Name of corporation, partnership or sole proprietorship: ___________________________

License No. (if any): ___________________________

Trade name(s): ___________________________

Number and street: (If a P.O. box, see instructions) ___________________________

Room or suite number: ___________________________

City or town ___________________________

State ___________________________

ZIP code ___________________________

Area code/telephone number ___________________________

Area code/tax number ___________________________

Country ___________________________

Is this a new address? ____ Yes ____ No

Application for (check as many as applicable and complete the designated Parts for the boxes checked):

Provide proof of legal name. Corporations must attach "Certificate of Good Standing." If applicant uses a trade name(s), attach "Certificate of Registration for Trade Name(s)" or other proof of trade name.

4. Describe the current business activities of the applicant (for example, custom house broker, NVOCC, air freight forwarder, etc.). If inactive, check here [____]

___________________________

5. Does applicant now share or intend to share office space or expenses with any other person or entity? ____ Yes ____ No (If "Yes," please identify that person or entity and explain the applicant's relationship with this person or entity.)

___________________________

6. Is any person or entity, other than the applicant or its principals, providing financial assistance to the applicant, such as advancing funds or collateral for the surety bond? ____ Yes ____ No If the answer is yes, please identify the entity: ___________________________

7. Has applicant or any of applicant's partners, officials, directors, or stockholders ever:

(1) been found in violation of any shipping or bill of lading statute? ____ Yes ____ No

(2) filed or been involved in a bankruptcy proceeding, other than as a claimant? ____ Yes ____ No

(3) been convicted of a crime, other than traffic violations? ____ Yes ____ No

If the response to any part of this question is "Yes," please attach an explanation.

PART B NAME CHANGE
To be completed by persons requesting approval of a name change or a change, addition or deletion of a trade name

8. New name of corporation, partnership or sole proprietorship. Provide proof of legal name. Corporations must attach "Certificate of Good Standing").

New name: ___________________________

Trade name(s), if any (attach Certificate of "Registration for Trade Name(s)" or other proof of trade name):

___________________________

PART C QUALIFYING INDIVIDUAL
To be completed by applicants for an ocean transportation intermediary license and replacement/additional qualifying individuals

15. Identify three (3) persons, unrelated to the qualifying individual or applicant, who have first-hand knowledge of the actual ocean transportation intermediary experience of the qualifying individual.

(a) Name: ___________________________

Title: ___________________________

Employer's name: ___________________________

FMC License No. (If applicable): ___________________________

Number and street ___________________________

Room or suite number ___________________________

City or town ___________________________

State ___________________________

ZIP code ___________________________

Area code/telephone number: ___________________________

Area code/fax number: ___________________________

Time period when person named above had knowledge of qualifying individual's experience: ___________________________

Nature of business relationship through which person gained first-hand knowledge of the qualifying individual's ocean freight forwarding experience: ___________________________

(b) Name: ___________________________

Title: ___________________________

Employer's name: ___________________________

FMC License No. (If applicable): ___________________________

Number and street ___________________________

Room or suite number ___________________________

City or town ___________________________

State ___________________________

ZIP code ___________________________

Area code/telephone number: ___________________________

Area code/fax number: ___________________________

Time period when person named above had knowledge of qualifying individual's experience: ___________________________

Nature of business relationship through which person gained first-hand knowledge of the qualifying individual's ocean freight forwarding experience: ___________________________
PART D OWNERSHIP AND AFFILIATIONS
To be completed by applicants for an ocean transportation intermediary license, business structure change, license transfer and, if applicable, changes resulting from personnel changes or replacement/additional qualifying individual

16. Applicant's ownership, directors and stockholders

Name of Officer/Director/Partner/Stockholder/Business Entity ___________________________

Title ___________________________

Percentage of Ownership ___________________________

Name of Officer/Director/Partner/Stockholder/Business Entity ___________________________

Title ___________________________

Percentage of Ownership ___________________________

Name of Officer/Director/Partner/Stockholder/Business Entity ___________________________

Title ___________________________

Percentage of Ownership ___________________________

17. Will applicant, its qualifying individual, or any officer, director, partner, or stockholder have a beneficial interest in shipments moving in the U.S. foreign commerce? ____ Yes ____ No

If "Yes," identify the name and address of each person or entity having a beneficial interest in shipments moving in the U.S. foreign commerce and the nature of such beneficial interest.

___________________________

___________________________

18. Is either applicant or its qualifying individual related to any other entity by reason of ownership, employment, or common officers, directors, or stockholders? ____ Yes ____ No

If "Yes," identify the name and address of each entity related to the applicant or its qualifying individual; the relationship or affiliation to applicant or qualifying individual and the type of business in which such entity is engaged.

I, ___________________________, certify under penalty of perjury ___________________________ (NAME OF SOLE PROPRIETOR) under the laws of the United States, that I have not been convicted, after September 1, 1989, of any Federal or State offense involving the distribution or possession of a controlled substance, or that if I have been so convicted, I am not ineligible to receive Federal benefits, either by court order or operation of law, pursuant to 21 U.S.C. 862.

Signature of Sole Proprietor ___________________________

Date ___________________________

I certify that I have received an read a copy of the Commission's ocean transportation intermediary regulations, 46 C.F.R. Part 515, and pertinent sections of the Shipping Act of 1984, as amended by the Ocean Shipping Reform Act of 1998 and the Coast Guard Authorization Act of 1998 (46 U.S.C. app. 1701 et. Seq.), governing the licensing of ocean transportation intermediaries, and that I will abide by all the provisions thereof from this date forward.

I further certify that I have specifically reviewed 46 C.F.R. § 515.42(h) (concerning the operations of licenses which are NVOCCs or which are related to NVOCCs) and 46 C.F.R. § 515.42(i) (concerning the operations of licenses which have a beneficial interest in merchandise exported from the United States by water or which are related to persons with a beneficial interest in merchandise exported from the United States by water).

I further certify that I shall not act as an ocean transportation intermediary as defined in section 3 of the Shipping Act of 1984, as amended by the Ocean Shipping Reform Act of 1998 and the Coast Guard Authorization Act of 1998, or perform ocean transportation intermediary services as defined in 46 C.F.R. Part 515, unless and until applicant is issued a valid ocean transportation intermediary license by the Federal Maritime Commission.

Under penalties of perjury, I declare that I have examined this application and to the best of my knowledge and belief, it is true, correct, and complete.